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Anyone have Tarsal Tunnel Symptoms after ESWT

Posted by dud on 6/11/04 at 22:31 (152798)

I had ESWT almost 2 weeks ago and just in the last few days my right foot has been having Tarsal Tunnel like symptoms. I tap on the inside of my right ankle..and I have those 'electric' pulse type of feelings all the way down to my toes..on the inside of my foot. It seems to be only worse at night...?

Could the ESWT procedure in any way bring on these symptoms..

My heel feels much better..but this pain is now worrying me.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Steve G on 6/12/04 at 00:01 (152799)

Could be that your pod hit a nerve when he gave you the shot. I have read on this board that such a thing has happened. I would ask the pod about this possibility. If it's true, it should improve with time.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Janice N on 6/12/04 at 06:30 (152804)

No but I started with that many yrs after a Neuroma removed. I hate that feeling. A couple of months ago
I tried using a hand held massger on that part of the foot. Bad idea!!!!!! It just intesified it. Gives me the wellies. lol

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

john king on 6/14/04 at 13:28 (152966)

My pod told me that if you have TTS then ESWT is a bad idea.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Todd W. on 6/16/04 at 21:50 (153209)

I had ESWT March 24th and I feel like it has caused TTS and another problem in my right forefoot that no doctor in the world can figure out! 2 days after ESWT my right forefoot swelled up and has been painful and warm, I am now getting checked for RSD. So BOY AM I HAPPY I HAD ESWT! Worst mistake I ever made in my life!!! I only had bad heel pain before ESWT, now after ESWT, I have the bad heel pain plus TTS symptoms(my heels just hurt all day the more I stand or walk the more they hurt) plus a bad swelling in my right forefoot that is probably RSD. So beware everyone, I think this is why there is so much controversy surrounding ESWT.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Dr. Z on 6/16/04 at 21:55 (153211)

Todd W.
Have you had any nerve conduction studies yet. It is possible that the nerve injection is related to your present additional problems. RSD can occur in almost any type of injury or surgery. I have never RSD with ESWT.
What type of machine and what type of local anesthetic did you receive?

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Todd W. on 6/16/04 at 22:06 (153215)

Dr. Z,
I had the Dornier Epos Ultra, all I know about the shots is that she gave me 3 or 4 in each foot to numb them up. I had no pain during ESWT. 2 days later I couldn't put any weight on right forefoot. After I get the nerve block done to check for RSD for the pain, swelling in right forefoot. I am going back to my pod to get that NCT. for TTS.
Dr. Z how would the nerve injection cause the pain, warmth, and redness(when my foot is down or below my heart), and swelling(top and bottom forefoot) symptoms? I really do not want it to be RSD(praying) I really appreciate any help you can give me. All four doctors I told you about couldn't tell me what it is Pain Clinic dr told me RSD and having a nerve block Tues. Thanks Dr. Z

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Dr. Z on 6/16/04 at 22:51 (153224)

Todd W,

This is very unusual. The nerve block can cause what we call a sympathetic effect. This is increase temp, warm, swelling but it isn't delayed and is usually short term and not two days later.
The lower back epidural will confirm RSD if it is there. RSD is as you know a disorder of the sympathetic nervous system due to any type of trauma.
The pain doctor who is usually very trained and experience with RSD problems and usually knows what he is talking about. We will have to wait until tuesday
The early diagnosis of RSD is very important and you are doing exactly what you should be doing to treatment RSD if in fact you do.

Please keep us updated

Dr. Z

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Todd W. on 6/17/04 at 10:33 (153272)

thanks DR. Z I will, I actually hope you will be here Tues. nite, I will let you know what happens. BTW what will happen if I don't have RSD? Could it be Osteomyelitis?
Dr. Z Thank you VERY MUCH!

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Dr. Z on 6/17/04 at 10:45 (153278)


You don't have a bone infection !!!. I will be here on Tuesday evening. Have you had an x-ray of your foot in the forefoot? I am sure you have had this.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Todd W. on 6/17/04 at 10:51 (153281)

yes I have and had a MRI, and bone scan, Increased uptake in both heels and in my right forefoot in the 3rd, 4th, and a little in 2nd toe or metatarsal. The Bone Scan also stated Osteomyelitis could not be ruled out. I have not had a cut in my foot or anything. Another question would be. Would Indomethacin take down the swelling in my forefoot, if I had RSD?? I was on it for 3wks, and it took the swelling down 50-60%, but not all the way. Currently on Vioxx to make it safer for stomach. Thank you DR. Z. Believe it or not you have been the most helpful of all DR. that I have seen,and I'm only talking to you on message board. Thanks DR. Z, sorry for all the ??? but I just want my life back, and you are already helping tremendously! Any other possibilities if not RSD?
Thanks DR. Z for being on here Tues.
Todd W.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Dr. Z on 6/17/04 at 12:21 (153292)

Here is the list the order means nothing
1. infection- mri should rule this out
2. Neuroma
3. TTS
4. RSD ( very strange but very possible
5. Stress fracture mri rules this out.

I think you have a neuroma and or stress fracture. Very strange why an MRI would pick this up. This is very hard to determine without a hands on examination.
Lets say this is RSD . Early aggressive treatment is the key to getting your life back

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Todd W. on 6/17/04 at 16:47 (153325)

DR. Z,
I do have a neuroma(a small one as my pod. says but she doesn't understand the swelling, says it shouldn't be like this. My xray and MRI and bone scan showed no fracture(that's what they thought at first too) She sent me to pain clinic suspecting RSD with the persistent swelling since March 26th.
I want to give you a complete exact background of what occured March 24th, if I could, you get back to me whenever you can...I know I have been asking alot of questions and you are busy, but you have been so helpful :).
March 2003-diagnosed with PF in right foot saw 3 doctors in 5 months span received 3 corizone shots in that time....not better
Feb. 2004-diagnosed with PF in left
March 12th- started having very mild tolerable pain in right forefoot...no swelling, no discoloration, no warmth.
March 24th- ESWT on both heels
March 26th- cannot put any weight on right forefoot
March 26th-went to fam dr. diagnosed me with Morton's Neuroma
went home later that day and iced only my right forefoot. Right forefoot swelled up could not see 2,3, or 4th metatarsals on top and swelling under ball of foot(not big toe)
May 2004-started taking Indomethacin, took down swelling in ball of foot 60%, top of foot not much
June 2004- saw Rheummy he checked my sacroillac joints and spine for Spondylitis problems and I had none. Changed me to Vioxx.
after that is where I am now, checking for RSD Tues. What do you think Dr. Z?
Would Morton's Neuroma cause this swelling, I feel like I have one. I can barely move my 3rd toe. Would Neuroma cause my right sole of my foot to be red(almost purple) when it is hanging or below my heart.
My heels hurt so bad if I'm on my feet for long, I will get NCT asap. If not I must have the worst case of PF ever!
Sorry this is so long DR. Z, just wanted to give you a complete accurate background to see if you have any suspicions? I know you can't see my feet but if you can give me any thoughts, it would be greatly appreciated. I will hopefully talk to you Tues.
Thanks a million(that is what I owe you now for all the help)
Todd W.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Dr. Z on 6/17/04 at 16:55 (153326)

Todd W,

We are going to have to wait until for the RSD evaluation .

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Todd W. on 6/22/04 at 16:36 (153712)

Well Dr. Z had nerve block done and ofcourse....nothing. So you were probably right and Me too...:) I didn't think so either.
It's pretty weird anyway because I don't have too much pain there unless I'm weightbearing and then it is unbelievable amount of pain, like most people talk about RSD. I asked him if he thought arthritis and he said no, and told me he thinks it is some type of soft tissue problem. He is having me take neurontin now, I don't think that will work either because I have been taking 300mg 2x's a day for 2wks. Another thing I hate about whatever is wrong with me is that my toes have changed(deformed) a little my right foot toes looks different(don't know if that is from the swelling or not)
Well my ins. is changing to my wives so I guess I can keep going to the DR. and trying to find one that can figure this out, maybe it's some type of bone problem. I feel like it is when I'm standing on it, like a toe pain or metatarsal bone pain.
Anyway, Dr. Z thanks for your help and if you have anything to add about anything such as if morton's neuroma could cause swelling, or what you think this may be I definitely do appreciate it. Thank you for all your help :)
Todd W.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Dr. Z on 6/22/04 at 17:20 (153713)


I am glad that the nerve block was negative. I still think you have some type of nerve irritation, and or neuroma syndrome. Each of your foot nerves needs to be carefully examined. If this is from the tarsal tunnel area it should clear up in six to eight weeks. An examination should help rule this out.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Todd W. on 6/22/04 at 18:00 (153715)

DR. Z,
I am happy too about not having RSD. So, you think my next step should be get with pod, and have an NCT scheduled ASAP? And if I do have some type of nerve irritation or whatever will the Neurontin help pain, swelling?Thanks

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

dud on 6/22/04 at 19:51 (153721)

I'm glad you do not have RSD. Hopefully your doctors can find out what is wrong with you ASAP.

I am now 3 weeks post ESWT and my ankle area still hurts with Tarsal Tunnel Symptoms (Positive Tinel Sign). It has now radiated down to my big toe. My POD still swears it is simply inflamed from the Foot Block and he says he doesn't need to run any more tests. He says the Nerve Conduction test I had in March ruled out TTS. However..I wonder if an acute injury from the needle to my nerve could cause TTS?

I am supposed to go back in 3 weeks and if it is not better..I am going to demand that he run more tests. I am now scared to have my left foot done by the same doctor. Should I be scared?? Or is it rare to cause nerve inflammation from a foot block. I also don't want to have any long term effects from these symptoms...

We will get by this!!

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Todd W. on 6/22/04 at 20:08 (153724)

I hope you find out about your ankle soon, maybe you will be better in 3 weeks. My pain dr. today said probably not RSD but he thought something like an individual nerve problem or something, I couldn't understand what he was saying.
Also, what is done with a TTS test?
Do they have to put needles in your foot?
Thanks for any info, and hope we both get better.
I just need to find the right dr.

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

dud on 6/22/04 at 20:22 (153726)

I was originally diagnosed with PF in 10/2002. My POD tried all the conservative treatment and nothing seemed to work. In 03/2004, to rule out TTS, he sent me to another POD in town to have my Fascia measured by ultrasound and also to rule out TTS.

My fascia on both feet measured close to 3X thicker than normal (6-7mm I think) ...

They then did this test for TTS where they used these little needles to stick the bottom of my feet. THe needles were connected to some type of machine which measured the nerve impulse. During the procedure I had to close my eyes..and the technician would stick these needles on various parts of my foot..and as soon as I felt them, I had to say 'NOW'. I also had to distinguish whether the tech was sticking with me one or two needles. I think they were timing my reaction to the needles. I guess a delayed response may indicate a nerve problem. They stuck me in about 50 places on both feet and the whole thing took about 20-30 minutes. It did not hurt at all. My doctor said I passed the test with flying colors.

Hopefully my pain is simply because of the foot block..and not really TTS. The worst part is not knowing exactly what I have and constantly worrying. I have got to quit worrying about everything..but it is so easy to do!!

This message board helps a lot to talk to people like you and realize that I am not along..Unfortunately it appears there are many others who are struggling with their feet. I wish you a speedy recovery!!

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Dr. Z on 6/22/04 at 22:07 (153736)


The neurotin could help as well as physical therapy ie ionophoresis, electrical stimulation,local nerve blocks. Very important to determine which if any nerves are the problem

Re: Anyone have Tarsal Tunnel Symptoms after ESWT

Todd W. on 6/23/04 at 10:06 (153753)

Dr. Z,
Should I just go back to my dr. and tell her, to do whatever is necessary to find out what is going on. This has been long enough, I want to get back in to size 11 shoes again sometime. Size 12 is too bid for my left foot. I'm really really frustrated and don't know what to do next. I have an appt. with my pod. July 2nd. Should I have another MRI done, one that would show my nerves? Should I have another bone scan? Something that would definitely show a neuroma also? What should be my next step. Dr. Z please advise..
Thanks for all your help, I promise I will leave u alone after this :)